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MCMAHON #1 BLK 6 LT 5
McMahon #1 Block Lot 5 #017-361-27 Municipality of Anchorage On-Site Water and Wastewater Program • (907)343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181432 PID Number: 017-361-27 Dwelling: E Single Family (SF) ❑ Duplex(D) 0 Multiple (SF and/or D) Project: 0 New 1 Upgrade Name: Edward Swegle and JyI Swegle ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench 0 Bed ❑ Mound 3930 Doroshin Ave ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-717-9589 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. McMahon #1 6 5 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well >100' NA N/A N/A >25' TANK El Septic ❑S.T.E.P. ❑Holding 0 Other Manufacturer Capacity Surface Water >100' NA N/A N/A Anchorage Tank 1000 Gal. Material Number of compartments Lot Line >10' NA N/A N/A 2 NA — Foundation >10' NA N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank replacement only Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Denali Excavating Drainfield D3034 CO/MT D3034 Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection r1 12/11/18 d Location and description dates: 2" V 4m Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ,.1 . ^1.1eklk 49 •. .. yi ' Benja• chiller �� �r��c•. CE 12592 \�`�r/� _� / ifl . 1 /15/18 , '� 4-- • Approve -� !� Date l Z" ��-e �i��v PRonssioNa� INN��� Inspection Report_9-1-12.doc MCMAHON #1 BLOCK 6 LOT 5 PERMIT # OSP181432 PID # 017-361-27 45 DOROSH{�N AVENUE ® ® LOT 5 1 r 1-7 100'WELL RADI LOT 4 �_ B 1 SV1 222.0 35.8 3 BDRM HOME SV2 28.2 37.8 , 2C0 31.5 38.5 , O /t FCO SV SV4I 2C• CO/MT 0 LOT 6 EXISTING NEW 1000-GAL TANK ABSORPTION TRENCH EgSFM�ivT i LOT 12 illiffiPGE I `���. \ NOTE: OF A&gkl`t ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS CO LEGCLEND i.�P• + PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC /��• 9 �t SYSTEMS. 2C0-DOUBLE CLEANOUT * 1N ;*�� FCO-FOUNDATION CLEANOUT FS FLOW SPLITTER VALVE 13:2. Benja m Schiller 0 50 100 MH-MANHOLE t#*'.. E 2592 . .4j/ — FEET MT-MONITORING TUBE l'��iF�PROFESS\0 1"=50' SV-SEPTIC VENT \�N�". -�- TH-TEST HOLE MCMAHON #1 BLOCK 6 LOT 5 PERMIT # OSP181432 PID # 017-361-27 O O 5 N> 0 — — 100.2 — — — I— — x95.1 v �— 94.2 94.17r1 io00 GAL 94.3 SEPTIC TANK J �� 90.2 9F Aq� _ tll *'49 N i\ •*+�j PROFILE AS-BUILT /��9F�.• CE12592111e` y��s`�' I: sFA.. Dec,7.10:8 ..44\`, illifeGE (NO SCALE) li,\\\\���~'-. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:llwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP181432 Work Type: SepticTank Upgrade Tax Code Number: 01736127000 Site Legal Address: MCMAHON #1 BLK 6 LT 5 G:2835 Site Mailing Address: 3930 DOROSHIN AVE, Anchorage Owner: SWEGLE EDWARD H & JYL A Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 1215/2018 12/5/2019 35324 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: // Date: Issued By: Date: MUNICIPALITY OF ANCHORAGE ® F-PLAUS Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-361-27 Property owner(s) Edward and Jyl Swegle Day phone 907-717-9589 Mailing address 3930 Doroshin Drive, Anchroage, AK 99516 Site address 3930 Doroshin Drive, Anchroage, AK 99516 Legal description (Sub'd., Block & Lot) McMahon #1 Block 6 Lot 5 Legal description (Township, Range & Section) Lot Size 35,324 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade FX -1 (w/wo ADU) Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -4,344— Waiver Fees: Date of Payment: 10LP11? Date of Payment: Receipt Number: ogggap Receipt Number: Permit No. dS p l y l as Waiver No. Permit App_'-'-:- .-.mac, December 3, 2018 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 12/3/18 Subject: McMahon #1 Block 6 Lot 5 Septic Tank Replacement Dear On-Site Services Engineer: The septic tank on the above lot is 43 years old, and the owner has decided to replace it. The existing home is a 3-bedroom. We are submitting this permit application for the placement of a new septic tank. The attached site plan identifies the location of the existing home, well and septic system, as well as the location of the new septic tank. The drainage pattern in general will not be changed by the construction. The existing tank will be pumped dry and decommissioned per code. It is a 1000-gallon tank and currently sits outside 10’ of the house foundation. It will be replaced with a 1000-gallon tank, and will be positioned outside the 100’ well radius and 10’ away from the foundation of the home. After the new tank, we will install a double-cleanout and connect into the existing absorption bed. A foundation cleanout already exists and will not be altered. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181432, Rebecca Carroll, 12/05/18 // // // // // // // //CL FCO 10050 0 FEET 1"=50' DECOMMISSION AND REMOVE EXISTING SEPTIC TANK REPLACE W/ NEW 1000-GAL TANK PROVIDE DOUBLE CLEANOUT NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO MCMAHON #1 BLOCK 6 LOT 5 Dec 04, 2018 3-BDRM HOME EXISTING ABSORPTION TRENCH 10' UTILI T Y EASE M E N T DOROSHIN AVENUE COCO/MT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181432, Rebecca Carroll, 12/05/18 a GREI �R ANCHORAGE AREA BOR JGH Department of Environmental Quality '" 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 7d1`t/t/(CR�d✓ MAILING ADDRESS?,09 ieB���� PHONE LOCATION LEGAL DESCRIPTION A60h/iON 4/l SEPTIC TANK: adeg�,(` oy DISTANCE f NUMBER / FROM WELL LLs,�_ MANUFACTURER MATERIAL �i�y� —COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYf ` GALLONS. TILE DRAIN FIELD: r f 1 TOTAL LENGTH DISTANCE FROM WELL/43t%FOUNDATION l0 NEAREST � AREST LOT LINE LINES NUMBER OF LINES ` DISTANCE BETWEEN LINES A14 TRENCH WIDTH— IN. TOTAL EFFECTIVE s i ABSORPTION AREA S26 SQ. FT. LENGTH OF EACH LINE �^ DEPTH OF FILTER 1 DEPTH: TOP OF TILE TO FINISH GRADE dA MATERIAL BENEATH TILE __�� — ABOVE TILE IN. WELL: TYPE 01�'ZdZV!� CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION—,LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM Ir INSTALLED BY:�a 0W�\ SEWER LINE DEPTH:y PIPE MATERIAL: SOtto �$i f0l se�v6« I/fiyh c:l�ia ovi r LOT SLOPE: REMARKS: l7�' DATE APPROVED 42& G.A.A.B. .orm EQ -032 GRE/' R ANCHORAGE AREA BOF �iGH ua DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 }. S f TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT I-INAME OF APPLICANT _�Xikf- 9vl?4f;yN MAILING ADDRESS .�/"•'+'^�/` PHONE-��-`�-- INSTALLATION LOCATION 4144 I Q FieMNN - LEGAL DESCRIPTION _Lo -r 6-- f3/k 6 C jq/-�/� &I 5;Z0 _1I INSTALLATION OF: SEPTIC TANK r SEEPAGE PIT I/- , DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED 6� �eo�''L✓�NG! T/�/HI �/ ���/� FINANCED THROUGH n TO BE INSTALLED BY SOIL TEST RESULTS �7 IjQ�/h NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST q/ �% COMPLETION DATE ANTICIPATED • ` 5 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. /Pc6VT SEPTIC TANK SIZE/® TYPE ia C"_46- A SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS J I FOUNDATION TO SEPTIC TANK 1 ' /o FOUNDATION TO SEEPAGE PIT --42140 DRAIN FIELD CC 1 SEPTIC TANK TO SEEPAGE PIT WALL I ' -. / �. DRAIN FIELD 40 SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK -SEEPAGE PIT DRAIN FIELD .00I , ALSO CONSIDER AREA WELLS. r SEEPAGE PIT WATER. MAIN TO SEPTI9 TANK DRAIN FIELD// W 1 I SEPTIC TANK, /, SEEPAGE PIT ,/Od DRAIN FIELI-lad TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. s O� DATE 7 APPLICANT'S SIGNATURE FORM NO. EQ -01 6 tA I I � � j } I —�– { T- _17 _ t I -- I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. s O� DATE 7 APPLICANT'S SIGNATURE FORM NO. EQ -01 6 Steve siverson 12 May 75_. McMahon V Fit The sediments were I i loose to fairly compact with a low moisture content. The Sp and S content was erratic so ry this test represents ar i #1AW SP average of 3 Parts SP to to 1 part Sm. Sm i I ilp 2A4. - e No Tt vb I D,&TE GVCJSS T'".11-2 T71 + - t ti I,; t h To 6 '-ft at 2 ------ calculated _average 175 eft/bdrm _12 May —7.5- 3 s Steve Siverson A ; 5 b McMahon E, XXya TOP - soil The sediments were fairl)" 2 _i loose with a low moistur¢ Gm icontent. There were soma terratic clay and silt nodules but these accouni i for less than 5% of the j total sediments. The e 5 �Sp-Sm was in an approximl I Sp (ratio of 3 parts Sp to jj and ` 1 part Sm. Ism ! No 12 May _ 75...... ... � A � 1♦M4 C ill } , 1 ; } ........gym,._:.._, .._�...,.. _ _ - i!gf :'? C, at._5�sg-ft/bdxm _ i�rn,,_: •.: ::ii �iy 12 "ay_..75.. M Certified Well ! For Steve SyV@Y'S�11 _.. --- - a. Location ..:Loin---- MOMahon Subdiui_s1 nvi � s ' Date completes ---- 6.13 075 _ �( Depth of well 1.79 Foet ---------- - Size 6 of casing .6...xno..h------ --- a , Distance to water : 1,522 M.' 9 Distance to water whilepumpingp' - 174. Feet of - - - ...._. at rate l'+. _... ----------- gallons per hour, Description of Formation from to a Sa d Gravel — Brn_Ifard � 0 1 p r lav Sand&Gravel ' Gre Med '10 � — _ 20 ; anti & Gravel BrnrlB Sof —" ' 20 2--- > _ 40 EL Gra.G & e . a 0 1 p Pizravw - la Sand& ravelBl__G v Me` _lav, Sand— e1Gr 1(4 = :. 1 a MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'APR 2 r' 1987 RECEIVED Dear r.,ir . FRob i nson ri1 . T am wI. I t 1 r g to 1 tFI -_ _sept t to ]iIr _irriu p r - _.at I one t ity concerning _, Health Au t`f Or' i tY A F: aril a.j Cer't I T i ra. to U7 to r, 1 :_i, S con tr'a[t_d =4—Fi!'_s Horne _er ':e5 to obtain ior Ill>:. Aga Ina thanks for Yof1r t 1 me arE r_I Ti_1 1 I e;.,;p 1 0.ii a,t ; n'_ 6':i I ! 1I r'e'_. pi e t ti : m VIJe=.t i rins. c'nc f c, sed I t a. l e i ter that T Have c r -i +tern t C t ri 1 s C ompany to i t h a. Q! 1 1 e x p! an it t 1 on of (:,I h a. t took F: 1 ac e ._ . i i d c on'_Ide r'I iIg t hi _.t 1 had contacted -/ou In th1c m.:kt to r { Tel t wa r on 1 . "f a.I r thit t '_rii rece I lie _ copy . 1 eis _r a. i rigid `.•'e'_ t .i' e had been great i i Nal r r .._ .� 1 r':�E.r , +fief' I�_ i_ girl 8. �r'�_ �' -t [o !'_er'n :_:n the part i_r-I- A—F1 +i s Hi me =eI'r.! i [es -arI:_ tine i r. I::1i:r.k.er _: b o u t t -i `:' t I me i y t f.vri ' n— ._. r :_r I_i nd of t h i s '_ w r' t have + i c: av t o an r; 1` d hope that those i the fUtUre who Teel thea ha.rvl l_ or e.:.:.pect a Gr- = b 1erl 1IY. e t h i to11j __;iraist i_"J r department Tarr ri r_ra.i n, 1 e n j C:r'ed t.1 !_t%Ing Jl t you and do appreC: i -ate ;'r 0 U rr t i me in this matter . ._., r... ti u 3 F'au,I TI_rr,er - :_ 0 o :_: =. it i ri A v e , _h _ _:: _ 995 s April 23, 1987 A -Plus Home Services 15900 Francesca Drive Anchorage, Alaska 99516 Ref: Adequacy Test - L5 B6 McMahan #1 Dear Barbara: The t�urpose in writing this letter is two fold and is not mneanf to directly accuse anyone in particular with repsect to the events that took place in obtaining the above certificate applicable to my residence. Needless to say I am notppleased with the time it took to obtain/deliver the Health thority Approval Certificate to me and this has caused an increase of $806.24 in closing costs on the refinancing of my residence. Also, I have personally talked with Mr. R. Robinson on 04/22/87 and he has assured me that the certificate in question was available for pick-up on the morning of 04/16/87 and that his departments secretary tried twice to contact Mr. Inman that day to advise him of the same. Also, Mr. R. Robinsonquestioned as to why no one attempted to pick this up on 04/17/87. As you are probablyaware, I first contacted A -Plus Home Services on 04/06/87,in the afternoon, and asked that they perform this service for me and I made mention at the time that I had talked with the Health & Human Services Department earlier that afternoon and they had advised me to expect a two working day turn -around on preparing the certificate if all paperwork was correctlysubmitted. You advised that your work would start on 04//87 and that Roy Inman would be contacting me. I advised my loan officer on the morning of 04/07/87 that this certificate should be available by 04/15/87 and this was an assumption on my part having received your word that work would being on 04/07/87. Upon arrival at my resident from work on 04/07/87 I called you as I had not been contacted with respect to this survey work and you had Roy Inman contact me that evening. The actual work inclusive of well check and sewer perk test was begun approximately 1000 AM, 04/10/87 and I was present for approximatley seventy-five percent of this work. Roy Inman contacted me at my work location on 04/13/87 in question of a sea] -ca for one of the ]each line inspection runs and advised me at the time that he was in the Dept. of Health & Human Services office preparing to,submit the paper work. I advised Roy that the seal -cap was installed and all was correct at my residence. M loan officer called the morning of. 04/16/87 and asked for the Health Certificate of which I did not have. Also I was advised that the points on the loan were at 1-7/8% for the day of 04/15/87 and these cannot be locked -in until the day of signing/recording. I called Roy twice after that and did not get an answer and with the holiday on 04/17/87 I waited and called you on the morning of 04/20/87. The certificate was delivered to my residence at 5:30 PM on 04/20/87. Upon my delivering the certificate to my bank at 9:30 AM on 04/21/87 I was advised that the points were now at 2-1/2%. This amounts to an increase of $806.25 in closing costs as stated earlier as compared to closing on this loan at 1-7/8%. I am very confident at this time that there was not a problem with this certificate not being available for pick-up on the morning of 04/16/87. Also I feel that if Mr. Inman or whoever reesenting A -Plus dome Services on contract to myself at the prtime, had pursued obtaining this certificate even to the extent of calling upon Mr. R. Robinson himself= that this costly expense to me could have been avoided entirely. The problem that you have expressed to me as being a delay with this public service department in the timely initiation of paperwork on their part could have been a problem but I do not feel that it was in this instance. Also, if this were to happen in the future with one of your contract customers I would hope that you, and those of you providing these "package" services, advise your customers of possible delays and I am sure that it can be avoided. As you are aware, I had stopped payment on my check to A -Plus Home Services as of 04/21/87 with the sole intent of satisfying myself first with respect to obtaining answers to all of my questions. I realize that I had contracted your services for this work of which a price was quoted. Enclosed is a check for your $600.00 fee. You and I have discussed the interest/concern of timely paperwork turn -around on the part of this city agency and I am thuroughly convinced that talking with Mr. R Robinson directly, even to the extent of each case in R. that positive results will be reached and questions will be answered. If I can be of any help in the future on this subject, feel free to let me know. Yours truly, Paul G. Turner 3930 Doroshin Ave. Anchorage, Alaska On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-361-27 Expiration Date: 1. GENERAL INFORMATION: S A r E T Y -� -C Complete legal description MCMAHON #1_: BLOCK 6, LOT 6 Location (site address) 3930 Doroshin Ave. *Anchorage Current Property owner(s) Chris Holland Day phone 907-787-9731 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 650 Waiver Fee $ Date of Payment 7 29 3 VX I Date Of Payment Receipt Number od 3776 Receipt Number COSA # /QaGZ 1 % 14 l �f Waiver # nil 5 -'STATEMENT OF INSPECTION BY ENGINEER _= As -certified by -my I -se I @I affixed hereto and as of the validation date -1. 1shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for -this application; shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Address: _3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the'iuture performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE .%, System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followi Phone: 907-337-6179 Date:�Fl .r #AECC884 tOF(( 4�(4, r ON SITE ti ula1\ T AND WA �L_vVATER o h p_l;z.nr�__ JJ. By: 1,111,1m Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory X Septic System Advisory Arsenic Advisory Well Flow Advisory Other r. COSA Checklist MCMAH0N ##1; BLOCK 6 LOT 017-361-27 5 _ be gad Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/30/75 Total depth 179 ft Cased to UNKNOWN .ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/10/21 Static water level at beginning of test 147.1 ft. _Comments B. TANK DATA Age of tank(s) 3 years Tank type/material SEPTIC/STEE Measured operating fluid level in septic tank 49" ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 8/1/75 ON ALL standpipes present per record drawing Total measured depth from grade 12.66 ft (max) Measured depth to pipe invert from grade 6.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective SUMP- 33- FMI Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced *2009 gallons Comments/Deficiencies: `PRE-SOAK PERFORMED ON 7110/21 COSA Checklist yellow sheet Structure served by this system Well production at time of test 4.3+ gpm Water storage tank volurne N/A gallons Well disinfected for coliform test? ❑ Yes M No ❑ Coliform bacteria is Negative Nitrate 6.42 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 7/11/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 7/11/21 Results [DPass For 3 bedrooms Fluid depth prior to test 31 in Water added 481 gal New depth 59 in Elapsed time 125 min Final fluid depth 47 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A E. SEPARATION DISTANCES Froin Private Well on Lot to: (Please enter distances if less than required or if comrnunity well) ❑ Yes if No Septic Tank/Lift Station on Lot > 100' If absorption field is under driveway comment below Property Line > 10' Community Sewer Manhole/Cleanout > 100' Yes (( Yes if No ft Water Main > 10' ❑✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Cj✓. Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' ✓❑ Yes if No ftCommunity Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑7 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation> 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100'✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' P1 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTAL[_ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with 9t-�- MOA COSA guidelines in effect on this date. , , , , , , . , , COSA Checklist yellow sheet U.,,`y - ... I- - ..... . 0� •_J�ffr y .... a ess., Q C�Ei 7953 953 �4eo frio fiessto\\oo� #AECC884 On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC211419 Subdivision: McMahon #1, Block: 6, Lot: 5 Fax: 343-7997 A water sample t'eveale-d-a--nitrate-coricL-riti'ation of 6.42 milligrams per liter (mg/L) ' - - - - --- , - - The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards'are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend YOU monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limit -s --t- h-"' e concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method .for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MUNICIPALITY OF ANCHORAGE S Q 1(tt .� SV:` .- Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 017-361-27 Expiration Date: Mcut)r X019 1. GENERAL INFORMATION Complete legal description McMahon #1 Block 6 Lot 5 Location (site address) 3930 Doroshin Ave Current property owner(s) Edward and Jyl Swegle Day phone 907-717-9589 Mailing address 3930 Doroshin Drive, Anchorage, AK 99516 Real estate agent Carla Nice of REMAX Dynamic Day phone 907-242-2427 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: L 2/ lL/ J Date: ir9//q/d COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52.p Waiver Fee$ Date of Payment 1a. Wig Date of Payment Receipt Number 66D/Lb Receipt Number COSA# 650911t41 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone 907-522-7773 Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 12/15/18 OF AL. k 6. DSD SIGNATURE zz x System #1 Approved for ') bedrooms / Benja 'nschiller . j System #2 Approved for bedrooms ��f jc�`��Fq. 12/15598 .�c,�r Disapproved 1` \PROFESSI� Conditional approval for bedrooms, with the following stipulations: IY t. ON SITE WATER AND WASTEWATER o 13 PROGRAM CRIT By: 0./1"-t,VC,G) CLr ��� fd ` Original Certificate Date: N?C 1 (AS S The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: McMahon #1 Lot 5 Block 6 Parcel ID:017-361-27 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/30/75 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 179 ft. Cased to >40* ft. Casing height(above ground) 36 in. FROM WELL LOG AT INSPECTION Date of test 6/30/75 12/3/18 Static water level 152 ft145 ft. Well production 20 g.p.m. 3.6 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 9.10 mg/L Arsenic ND ug/L Date of sample: 11/19/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 12/11/18 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping Pumper New Tank C. ABSORPTION FIELD DATA Date installed 8/01/75 Soil rating (g.p.d./ft2 or ft2/bdrm) 175 SF/BDRM System type Deep trench Length 28 ft. Width Unknown ft. Gravel below pipe **1 0 ft. Total depth ft.ft. Eff. absorption area 560 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/4/18 Results(Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 31 in. Water added 453 gal. New depth 31 in. Elapsed Time: 1440 min. Final fluid depth 31 in. Absorption rate >= 450 g.p.d. none Any rejuvenation treatment(past 12 mo.)(Y/N &type) If yes, give date • D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot X100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' ' Sewer/septic service line >25 Holding tank 1 00 Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: >1 Building foundation 0 Property line >5 Absorption field >5 10' >1 >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10' Property line >1 Building foundation >1 Water main >10' Water Service line 1 Surface water 100Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS *Casing depth taken from previous inspection reports. **Monitor tube is filled with debris at the bottom, 8.2' effective depth recorded at test. G. ENGINEER'S CERTIFICATION ...„....„..-.0..\\‘‘‘‘ of � ll I certify that I have determined through field inspections and tQ review of Municipal records that the above systems are in /��4P'•••• `4 .9##� i conformance with MOA COSA guidelines in effect on this date. *:•4 TH )\ • *y Engineer's Printed Name Benjamin Schiller, PE 12/17/18 • Date �, Benja•' chiller : r#i 1.4"• CE 12592 ...`k(�/ J' 12/17/18 �tlue PROFESSION...�' COSA brown sheet 10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT I/!!,"" 907-343-7904 On-Site Water and Wastewater Section `' / Fax: 343-7997 www.muni.org/onsite Nitrate Advisory' Certificate of On-Site Systems Approval # OSC181641 Subdivision: McMahon #1, Block: 6, Lot: 5 A water sample revealed a nitrate concentration of 9.1 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org L DOROSHIN AVENUE — — 8479R 0 co O Cr) — — S 88°05'00" E 145.00 f r 0 , ' Lot 5 welly tv ' covered 1\ storage 421,1.14,„u. 24.0 ' x •eck M N" a; f1 S. -54.6 _ ti M 4.0C° O N 1 ry N x /4)4 1. Frame Sto2.• W 1 2.0 OH - ?House ,- v kill III . O ZD o deck / N O clean out0 W I` -: e 0° 0Lot 6 I septic `wire fence (typ) 00 / vent (typ)'/ 0 I O U) \chain link fence (typ) N7 /-&Utility E 5°42'04„ wasement -- , ` SCALE: 1"= 40' 149.6, `,N�N.N.% 1 RECERTIFIED 12-18-18W �� OF • q� Lot 12 I AS-BUILT NO CORNERS SET THIS DATE �Q•• • • •S,� is I hereby certify that I have performed a Mortgagee's inspection `) •• . , I of the following described property: Lot 5, Block 6, 49th /1 • •444• �� McMahon Subdivision. 1st Addition iiI7°• • Anchorage Recording Precinct,Alaska,and that the improvements situated thereon are within the property lines 1,i:i lizabeth •. Walatka :fro/ and do not overlap or encroach on the property lying �sIs•• 8036 - LS ••• •���� adjacent thereto,that no improvements on the property lying 1 lFQ • . • o`' , adjacent thereto encroach on the premises in question and ' A,,? • • • • • .tea A. that there are no roadways,transmission lines or other t ` s Alb visible easements on said property except as indicated hereon. t 2 _ �� - Dated at Anchorage,Alaska EASEMENTS OF RECORD, OTHER THAN this 19th day of November ,2018 THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON FRED WALATKA v ASSOCIATES,L.L.0 UNLESS OTHERWISE NOTED. FB 18-9, pg 34-35 MB Engineers and Surveyors 907-248-1666 Municipality of Anchorage o N9,.;' Development Services Department =: Building Safety Division On -Site Water and Wastewater Program s . , T ,r 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DI - 3(0I COSA# Ds tl5 Expiration Date: % 0 11-L— O S GENERAL INFORMATION Complete legal description Location (site address) 343o dorosg,� /iven�e ICat`e yang Dayphone 522- 2539, Current Property owner(s) � Mailing address Day phone Lending agency Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 3. TYPE OF WATER SUPPLY: El Individual Well ® Individual On-site ❑ ❑ Individual Holding Tank Individual Water Storage ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 brow n are pend ed fent aro a sional civil engineer registered in the State of Alaska. Certificates of On -Site Systems App title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Address Engineer's Printed Name 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 279.39/& Date 7/1 oB OF. At It 49TH::.?,//� E- PUAKLAt,-o 115^0 Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory _�_ Other By.2. Original Certificate Date:CA Municipality of Anchorage --=1 Development Services Department _ Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: McMd�o' 411 d(v _k G (.o} $ Parcel ID: ©� %7 � (9 1 —a 7 A. WELL DATA Well type Privaft If A, B, or C provide PWSID # _ Well Log (YIN) y Date completed 4�S Sanitary seal (YIN) � Wires properly protected (YIN) y '� Total depth �ft. Cased to 40 ft. Casing height (above ground) +12 in. FROM WELL LOG Date of test _ `/30 55 Static water level 15 2 ft. Well production ZO g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 8.41 mg/L AT INSPECTION Zf o8 y3 g.p.m. Arsenic: nVD uglL date of sample: 5 09 B. SEPTIC/HOLDING TANK DATA Tank Type/Material ro Slee Tank size 1000 gal. Number of Compartments # Foundation cleanout (YIN) � Depression over tank (YIN) Y Other bacteria —colonies/100 mL' Collected by: 1 APS S0vr1z14_� Date installed B / 75 Cleanouts (YIN) Y High water alarm (YIN) N Date of pumping 9 z9 0$ Pumper A+ N�Mc $eruiceo C. ABSORPTION FIELD DATA Br o6 Soil orfelbdan) Ii5 System type DEEP T�Cnc� Date installed 9 �� Length 3�e __ ft. ,.' Width Z*' ft. Gravel below pipe IOr ft. Total depth 13 ft. ' Eff. absorption area 515 fe Monitoring tube y Depression over field N .Date of adequacy test 4 t9 08 Results (Pass/Fail) Foss For 3 bedrooms Fluid depth in absorption field before test 46 in. Water added I Igo gal. New depths in. Elapsed Time: q03 min. Final fluid depth 50.5 in. Absorption rate >= 450 g.p.d. (past 12 mo. IN & e enc y""A If yes, give date = Any rejuvenation treatment (p ) i tyP ) D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) 'Pump on" levet —in. 'Pump off level _ in. High water alarm level in. Datum Cycles to d Meets alarm �cuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001f- Absorption oor*Absorption field on lot 100 rf Public sewer main N/A Sewer /septic service line 25 I+ Animal containment areas 5or+ On adjacent lots Ioa4 On adjacent lots loo, Public sewer manhole/cleanout A/ JA Holding tank !Y44 Manurelanimal excrete storage areas loo t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5t- Property line 5 + Absorption field 5 ra Water main lo,+ Water service line to'+ Surface water Al o, Wells on adjacent lots too'. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'* Water main to' + Water Service line 10 r+ Surfacewater moo.if- Curtain Driveway, parking vehicle storage 10 } Curtain drain NO. Wells on adjacent lots 100 a F. COMMENTS G. ENGINEER'S CERTIFICATION pF A4,1 �1' I certify that I have determined through field inspections and 1 0j Q s 0 �, review of Municipal records that the above systems are in : t}gTH W 1� conformance with MOA COSA guidelines in effect on this date. t rc„ r_•: • • t Engineer's Printed Name L Aa5 -S ur Rk ar.d /�, •• IARS E. SFURKLAN115 0 D: Date_ �� It .100 I � COSA Fee $ Date of Payment Receipt Number_ Oi5ii243h (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department ' •i`� Building Safety Division ., On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080225 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 6, Lot 5 of McMahon #1 subdivision. This inspection revealed a nitrate concentration of 8.71 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. ,J Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK ' 99519-6650 www.ci.anchorage.sk.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 017-361-27 1. GENERAL INFORMATION HAA Expiration Date: 1�7- 2 3 ` OS Complete legal description McMahon S/D #1• Rlock 6,J of s Location (site address or directions) 3930 Doreehin Avenue, raae. oAK 44516 Current Propertyowner(s) Rill Toney Dayphone 974-1028 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: R 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Cl Community Class Well. ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL.: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of FirrtLKND FN ,INFFRIN ,Inc Phone (907) 646_61 U Address ?0441 Ptarmigan Blvd, Fagte Rim, AK 94577 Engineer's Printed NaDate ?/17/05 Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes In land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist x Septic System Advisory Well Flow Advisory bedrooms, with the following Maintenance Agreements Supplemental Engineers Report Other •• •�• Oji ON-SITE •'•, WATER AND ; WASTEWATER : PROGRAM By: (j - / Original Certificate Date a - . L✓f!/ Municipality of Anchorage Development Services Department 46-11' Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description, McMahon #1. B6. LS Parcell lD: 017-361-27 A. WELL DATA Well type rle Yate If A, B. or C provide PWSID # Date completed 6/30/1975 Sanitary seal (Y/N)Y_ Total depth 179 ft. Cased to 40+ t1. FROM WELL LOG Date of test 6/30/75 Static water level 1 5 2 ft. Well production 20 9 -p.m WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (YM) Y_ Casing height (above ground) 3 ' AT INSPECTION 149 ft. 3.53+ g.p.m. Coliform __colonies/100 m1.Nitrate 3.96 mg•/I.Other bacteria 0 colonies/100 ml. Arsenic: .NA mg.A. Date of sample: 2/9/05 Collected by: KND Engineering- Inc. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed B / 19 7 5 Tank size 1000 gal. Number of Compartments Cleanouts (Y/N).Y Foundation cleanout (Y/N) Y --Depression over tank (Y/N) N High water alarm (Y/N) t1 Date of pumping 2/4/05 Pumper McDonalds C. ABSORPTION FIELD DATA Date installed 8/1975 Soil rating (g.p.d./fe or felbdnn) J115L System type TRENCH Length 28 ft. Width unknown ft. Gravel below pipe 10.0 ft. Total depth JM ft. Eff. absorption area J?j ftr Monitoring tube Y Depression over field H Date of adequacy test 2/$/05 Results (Pass/Fail) PASS For 3_ bedrooms Fluid depth in absorption field before test 33.6 in. Water added 450 gal. New depth 93.6 in. Elapsed Time: 1190 min. Final fluid depth 34.8 In. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.)'(Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Acoess (YIN) "Pump on" level at in. "Pump off" level at_ in.High water alar level at In. Datum Cycles tested Meets alarm 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ On adjacentlots 100'+ On adjacent tots 100'+ Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10 1 + Curtain drain 50'+ Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certlly that I have determined through field inspections and �,tp�a••""'•�M'QS'�� review of Municipal records that the above systems are in rGj conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Kenneth M. Duffus Date 2/17/05 �1.3ih CE71*1 HAA Fee $430.00 Date of Payment a'f )s105 Receipt Number (Rev. 1201) Wanner Fee $ Date of Payment Receipt Number 06/25/00 TUG 00:57 FAX 508 253 4261 U.S.BANK.ILMING('ON -ti • � D on _ rJ h i zw d exiv7IMCA I `9duse srvric ,—�.. • �i • U002 I Hereby teztup tbae `IDave aaveyed the following described propert7: L oT 5 $txr (o (lIt e MA}{or i SUED. L�pb, �. AJo l and that no enaoarlm=r-s exist except as indicated. Exclusion Notes �b•.,L� �•,��` It is the responsiMlitf of the Diner to determine the exis"me of airy eammz s. t,% . ....... 0� eoveuanta, or rastrictiau %hich do not appear on the recerded m±divisien plat. ol..�:•� .��h Under no e3mnustatrae should data 110rCfln be used for eORstruCCion or for � �7; p establishiM bo xlmy or furs limes. P... mted at Anehoraga, Alaska, this 7 day of.4r•� � (q$7 . 0 .e —r i o r n�.ra a LS -2233 ; • ;,•� 8=JAS B U I LT P� P•........•ti:,��o eeriarwod street �a F,.�.. , e;. o -�� Phan (907)344.2407 a: N W V o d • 3 i :qo• • � � �l/Ff0 �6= � o Fe��a-•v9 U002 I Hereby teztup tbae `IDave aaveyed the following described propert7: L oT 5 $txr (o (lIt e MA}{or i SUED. L�pb, �. AJo l and that no enaoarlm=r-s exist except as indicated. Exclusion Notes �b•.,L� �•,��` It is the responsiMlitf of the Diner to determine the exis"me of airy eammz s. t,% . ....... 0� eoveuanta, or rastrictiau %hich do not appear on the recerded m±divisien plat. ol..�:•� .��h Under no e3mnustatrae should data 110rCfln be used for eORstruCCion or for � �7; p establishiM bo xlmy or furs limes. P... mted at Anehoraga, Alaska, this 7 day of.4r•� � (q$7 . 0 .e —r i o r n�.ra a LS -2233 ; • ;,•� 8=JAS B U I LT P� P•........•ti:,��o eeriarwod street �a F,.�.. , e;. o -�� Phan (907)344.2407 Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services it On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # W�'I n :.L 1. GENERAL INFORMATION Complete legal description uc.) ' �IL �� S/-" Location (site address or directions) � of 3 DD Cc H+i^l - AV F Property owner �I L ��~ Day phone Mailing address Lending agency NIA Day phone cJ IF Mailing address I� Agent �c��(� C`"'�-' �""'^'� Oa2- Day phone -762-3 IZ i Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well o� a4c--_74-9-�; MUNICIPALITY OF ANCJIORAGE ENVIRONMENTAL SERVICES DIVISION Community well Public water JU��L^^ 6 ]996 NOTE: If community well system, provide written confirmation frbYr�-3Satettest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAM21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Alaska b".atsr & 8471 Engineer's signature � VGlVV� Cid_= 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: %uTic Phone _ _ Date e 337-6�-7% "OF C , S - ._-4 bedrooms, with the following stipulations: Date 7 — 2 ?- ZZ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional eng;neer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage f �RONEMA( SOtANCyO r, DEPARTMENT OF HEALTH & HUMAN SERVICES �V ERS/CES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 34314744 26 1996 Health Authority Approval Checklist U Legal Description t-o`r 5 B K (, ) M MA-Ik-�n7 Parcel I.D.: O t -7 3 6 I A. WELL DATA Well type PV7- If A, B, or C. attach ADEC letter. ADEC water system number Log present (Y" "-I P— S Date completed b L2o/-K— Total depth 1-7 cl Cased to 4014- Casing height (above ground) '/' Z Sanitary seal (Y/N) \/ 1✓S Wires properly protected (Y" FROM WELL LOG Date of test 6 /3 `� /! -S7 / Static water level / 5Z Well production ZO AT INSPECTION g.p.m. 5 3.45 g.p.m. Fol 152- Mj"tiT6=&. -r.D.D =3.5 WATER SAMPLE RESULTS: Coliform SZt Nitrate �'� Other bacteria Date of sample: 7114-`9L Collected by: 4�*�SS B. SEPTIC/HOLDING TANK DATA Date installed ea 7� Tank size 10000 Number of Compartments P Cleanouts (Y/I) OM>c Foundation cleanout (Y/N) Depression (Y/N) N * High water alarm (Y/N) � Date of Pumping 2S 4 Pumper A PLUS S 1_i G rte- p ssas� *4�7e- Date C. ABSORPTION FIELD DATA L'oP�—or- SoIC,• installed g/?S- Soil rating (g.p.d./ft2 or ft2/bdrm) 1 i 5� System type i i2��JGy1 Length Z6/ Width VNY-+JoW+J Gravel thickness below pipe B' Total depth r� �✓-+�Svre.�(Svnp Noy- 0�.7 Bor-�•o^+ ?/ Effective absorption N area 525 Monitoring Tube'present(Y/N) Y Depression over field (Y/N) d Date of adequacy tet-7/ZS9� Results (Pass/Fail) P'H'.�S For 3 bedrooms Fluid depth in absorption field before test (in.); Z_ 4 Immediately after5ZOgal. water added (in.):'7S• S Fluid depth 6 0 (ins.) Minutes later: I $ O Absorption rate = g.p.d. NOn1E N Peroxide treatment (past 12 months) (Y/N)L�1.N7w rJ If yes, give date (D 19"15 1r154E�-�o ) P��oIL� G TION 1\J JtT Date installed Manhole/Access (Y/N) High water alarm leve C ,�elc tested E. SEPARATION DISTANCES Size in *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: J Septic/holding tank on lot 1 3 ; On adjacent lots r Absorption field on lot ( - ; On adjacent lots Public sewer main N Sewer /septic service line "Pump off' level at* > (D&DI Public sewer manhole/cleanout N/ Lift station N/i SEPARATION DISTANCES FROM SEPTIC/H6EB NO TANK ON LOT TO: PFSA}-ag ,'rSU9 Building foundation ZD.5 Gin Property line 50 s Absorption field Water main/service line ' ° Surface water/drainage >I oo Wells on adjacent lots oerosrrr s,p6S or- ✓ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: FfLoh CWSESi Building foundation 33.5 &10 Water main/service line 0 opPOS 1-6 s. PES Oh tlovS�R 0 Surface water (Do Driveway, parking/vehicle storage area 6o { N O rJF' J± Curtain drain t�,o.On% Wells on adjacent lots >- O Property line F. ENGINEER'S CERTIFICATION spection.s and review of Municipal in effect on this date. Engineer's Name /IA4� - � A - Date '7/Zj�/jo 6 HAA Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number An °. a oo•,".t�P�' 1 July 25, 1996 Alaska Water & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On -Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 Ref, HAA for Lot 5, Block 6, McMahon S/D. To whom it may concern: .i OF •, ...... t, to �.•s.• em • m • .e n:.Y {®R eyA.Gar ® cP •i CE -7953 t'jAF Q•m••.Nm•a •�y ROFESSi0��� The subject property has a 3 bedroom house which is served by a private well & septic system. Comments regarding the well and septic are as follows: WELL: The static level was 154.5 feet. Water was pumped at a rate of 3.45 gpm for a total of 174 minutes (600 gallons). The water level in the casing quickly dropped 3.5 feet, and stabilized thereafter. Upon completion of the pumping period, the well recovered completely in several minutes. Based upon this data, the well was deemed to be adequate for a 3 bedroom house. The capacity of the well meets the FHA requirement of 3 gallons per minute. SEPTIC SYSTEM: The initial adequacy test was run on 6/25/96, however, it was determined that the water level in the 6 inch sump was not representative of the liquid level in the trench; consequently, a monitoring tube was installed, and the system retested. Twenty-four hours prior to retesting the system, it was presoaked with 1150 gallons of water. Prior to starting the adequacy test the water level in the monitoring tube was 42.75 inches. Water was introduced at 3.22 gpm, for a total of 161 minutes (520 gallons) the water level in the monitoring tube rose 31 inches, to a total depth of 75.5 inches. This corresponds to 16.8 gallons/inch. The water level was monitored 180 minutes later, and it had dropped to 60 inches, a recovery of 260 gallons. Based upon this data, the trench was deemed to be adequate for a 3 bedroom house (450 gallons per day). NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this septic system SEPTIC TANK CONDITION: A depression was noted just before the septic tank clean-out. According to the homeowner, Paul Turner, the depression has been there since he purchased the house in 1987. Whether this depression is an indication that the tank is collapsing is uncertain. Regardless, given the age of the tank (21 years old), it is reasonable to assume that it is reaching the end of its useful life. The next homeowner should anticipate replacing the septic tank in the not to distant future. There appears to be adequate room on the property for the subject upgrade. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, i JeMi . Garne .E., M.S. Owner/Consultant c.c. Jack White Real Estate Oim Paul Turnerl.wps CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. Laboratory Division ~,~,,~,,e,,~-,~r~r.~-,~-j,~a~'jj. arjJ,~',~'~ 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: {907) 562-2343 Fax: (907) 561-5301 963038001 AK Water & Wastewater Services 3930 Doroshin 3930 Doroshin Drinking Water Client PO# Printed Date/Time 07/26/96 08:31 Collected Date/Time 07/24/96 00:00 Received Date/Time 07/24/96 13:30 Technical Director Released By ~~. Sample Remarks: Parameter Nitrate-N Total Coliform Allowable Prep Analysis Results PQL Units Method Limits Date Date Init 5.57 0.500 mg/L EPA 353.2 07/24/96 ESC 0 0 col/lOOmL SM18 9222B 07/24/96 TAV ~~ Member of the SGS Group (Soci6t~ G~n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY �+ 264-4720 Application Date April 12, 1987 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Zot 5 Block 6 McMahan Subdivision Location (address or directions) 3930 Doroshin (b) Applicant Name Paul Turner Telephone: Home 345-7407 Business 265-8812 Applicant Address Same (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder CX; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution NA Telephone NSA Address NA (e) Real Estate'Company and Agent N/A Address NA Telephone N/A (f) Mail the HAA to the following address: ; Please hold fob Dick up by Roy Inman 729 2. TYPE OF RESIDENCE Single-Familyll Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well IM Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 10 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Whitewater Engineering Telephone 345-7008 Address 11600 Cange Road, Anchorage AK_ 99516 Date April 12, 1987 9TH H a¢ i"'•r••• ....;•k Engineer's Seal �... ...::....c,.•.. S 1780M A. FISCHER Q c;� •. CE - 6793 C� s0 6. DHEP APPROVAL Approved for bedrooms by 2grj "_n 'J' 2!/_ J Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-02e n veal MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 APR 13 1987 264-4720 Legal Description: Tot 5 Block 6 RECEIVED McMahon Subdivision A. WELL DATA RECEIVED Well Classification Private If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/N) Yes Date Completed July 9, 1982 Yield Total Depth 179' Cased to unknown Depth of Grouting N/A Static Water Level 167' Pump Set At Unknown Casing Height Above Ground 30,E Sanitary Seal on Casing (Y/N) yes Electrical Wiring in Conduit (Y/N) Ves Depression Around Wellhead (Y/N) no Separation Distances from Well: To Septic/Holding Tank on Lot 113 ; On Adjoining Lots 100,+ To Nearest Edge of Absorption Field on Lot 113' + ; On Adjoining Lots 100,+ To Nearest Public Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot N/A Water Sample Collected by Roy Inman ; Date April 91 1987 Water Sample Test Results Satisfactory Comments B. SEPTIC/HOLDING TANK DATA Date Installed 08/01/75; Size 1000 No. of Compartments 1 Standpipes (Y/N) yes Air -tight Caps (Y/N) yes Foundation Cleanout (Y/N) yes Depression over Tank (Y/N) no Date Last Pumped 10/29/86 Pumping/Maintenance Contract on File (Y/N) N/A ; for N/A Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 113' To Building Foundation 18' To Property Line 50' To Disposal Field 10' To Water Main/Service Line 25'+ To Stream, Pond, Lake, or Major Drainage Course 100,+ Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ 1775 1)er brm Type of System Design trench Date Installed 05/14/75 Length of Field 28' Width of Field 36" Depth of Field 1f6' Gravel Bed Thickness 10' Square Feet of Absorption Area 525 Standpipes Present (Y/N) yes Depression over Field (Y/N) no Date of Last Adequacy Test April 12 , 1987 Results of Last Adequacy Test--SatisfaOtOry Separation Distance from Absorption Field: To Water -Supply Well 100,+ To Property Line 10' To Building Foundation 28' To Existing or Abandoned System on Lot __ N/A ; On Adjoining Lots "30'+ To Water Main/Service Line 500+ To Cutbank (if present) N/A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments I nhole/Access (Y/N) "Pump Off" Level at — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I . e checl.ked, veri 'ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed ��� ` ate _April 12, 1987 Company _Mitewa.ter Eng. MOA No Receipt No. (2)(0 CD C) Z— 4��4 `J ? ,e• Date of Payment 7 — 1 J —�� er�� ,•' 4�' �} / r) Q 00 0CO), TR '.`,C� ��'Engineer's Seal Amount:$ 4G�_ F ... .......... .....e.. _.. ®..; THOM A. FISCHER Page 2 of 2 �Q A CE - 6793 Qs4t� 0 oma,, •,' O� 72-026 (11/84) � CSS1Dtg4- ;."]me - Time r , Date Date Date Inspector Inspector Inspector Comments Conditional Approval 2-q�g� C� Date Sewer Installed j _,._ y Permit No. Septic Tank Size / Od C) �� Holding Tank Size Soils Rating - Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Oct r w h e r Phone Mailing Address Buyer /We/x( mop/y Address / '6�A-rOy Lending Institution se fjC� fyj� pyrmr�s _ /� i Phone Address ltyCo. &AgentSP!^UicCaress Phone 3t 0ue-, qn n�6, /10 Legal Description p'f IVY, Mahoo �C4 Street Location Type nce l Single Fa � Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water ¢ply L$%Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sew sposal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ALASKA CnUInOWnTAL C011TROL SRUS, Inc. Cngineerinq & l3nuironmental Studies 05/17/82 PERSONAL SERVICE REALTY 1236 W 10TH AVE ANCHORAGE AK 99501 SELLER — LAWENER BUYER—MORLEY SUBDIVISION—MCMANN #2 BLOCK -6 LOT -5 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A DRAINFIELD WITH AN AREA OF 525 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 800 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 5/17/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1220 West 25th Auenue • Anchorage, Alaska 99503 • (907) 276-1361 P,. O O s� 9a A�APLO JAilUA4� �. J 1 2. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received % � \ % - 7 S Time of Inspection 1�(; `3 O Date of Inspection - - Z S REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: Ips � Phone: rp-el y Property Owner% ��,�,,g�r,.�, Phone: '2> LI Lk Mailing Address: 3. Legal Description 4. Location: 5. Type of facility to be inspected No. of bedrooms 6. Well Data: . A. Type fC B. Depth C. Construction (� D. Bacterial Analysis 7. Sewage Disposal System: A. Installed - - 1 s B. Installer — C. Septic Tank: 1. Size o a o 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank &V �, Absorption area l �D �f Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner:�O�li� Mailing Address:>ya'GrIlAay Phone 3. Name of Buyer: %irlC/%J�r Mailing Address: Day Phone 4. Name of Lending Institution: Mailing Address: ���/ Phone Agent: 5. Name of Realtor or Mailing Address:�;��`% Phone 6. Legal Descripti n: hfJ/ �� ,�"��n / Alk--IZ2 Location: - 7. Type of Facility to be inspected: 1W,11 No. Bdrms.�� 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served 1 If individual, depth of well 9. Sewage Disposal System Type:of System: Public Utility /Individual (on-site) If Individual, date of installation LJ/ k /�'�� 'Page 2 of two pages - Req' t for Approval of Individual S T & Water Facilities Legal Descnription Comments Approved �-. N, GDi sapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74)